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FOR OFFICE 115E <br /> - <br /> APPLICATION FOR SANITATION PERMIT f 3 <br /> _ _._...... Permk No:.Ib............ <br /> (compleb in TdpBsafai <br /> ........................................__............ <br /> 1 This FormitExpires I Year Prom Dab Woad Date Issued . <br /> Application is hereby made to the San J,quin Local Health District for a permit to construct and Install the work herein <br /> described.This application is•made in Go Ila wt my qdirlanca No. 549 and existing Rules and Regulatioro: <br /> J08 ADDRE55/L ._/L/ ._.._� 1.'��.. .. ---------------- .....,....CENSUS TRACT ....................... <br /> Chvner's Name �j _ _..... -..-_. _ ..' ..--.....__..... -.. __ .Phone _ <br /> .- -.-..__-------------_._._.. <br /> Address _....--..P- S_.. .v�.•�. ... --.:.. .._ .. ._... City--- ...._..................—'...._. <br /> Contractor's Name..-. license ds .� 3.ff.7'�Phone .............................. <br /> Installation will server---Resldence A irtment House Commercial[3Trailer Court 0 <br /> Motel r]bitter--------. .......__.------- <br /> .-.----------- <br /> Number of living units;.-..�l...-�.Number'af bedrooms - ...Garbage Grinder .........— Lot She .._4:.- — <br /> Water Supply: Public System and name .............------_------ .._._-..._...............Private <br /> Character cf soil to a depth of 3 feet: Sand r] Silt❑ Clay ❑ Peat 0 Sandy Loom�j ClayLoam 0 <br /> Hardpan❑ Adobe'[] Fill Mater)&I --. ---If yes,type................. <br /> (Plot plan, showing size of lot, location of system In rotation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted N public sewer Is available within 200 fwtl <br /> PACKAGE TREATMENT [] SEPTIC TANK II Size-----__.-_.--__..-_.....---------------- Liquid Depth — I <br /> Capacity-__.__._ _ . Type _.....:........... Material—_................. No. Compartments <br /> t <br /> Distance M nearesh Well ....................................Foundation..................... Prop.Una <br /> LEACHING LINE f I No. of Lines ..............__...... Length of each line.................... Tota[ Length :....._............ <br /> _.. , <br /> •D' Box ............ Typo Filter Material _.----.___........Depth Filter Moterlol ......................._.._............ <br /> Distance to nearest, Well .._ Foundation ........... Property Line t <br /> SEEPAGE PIT [ l Depth .................... Diameter ......_....... Number ........................... Rode Filled Yes ❑ No O <br /> Water Table Depth ___._ ::_..r._.._.Rock Size..........._....._.__.»_- <br /> Distance to nearest:Wel[ ........._._____,......_Foundation .................... Prop. Line....... <br /> REPARt/ADDITION(Prev. Sanitation Permit$......_..._..._—.------------------ Date _........_....... <br /> .�._-__i <br /> Septic Tank(Specify Requirements) --•--••• ....... ---••• ._..-._..__ t <br /> Dis ;ol FFely IS Requ mems) ._.. -.. .-__ <br /> �Qr <br /> (Draw existing and required addition on reverse olds). <br /> I hereby certify that I haw prepared thh application and that the work will be done In accerdance with Sen Joaquin <br /> County Ordinances; State Laws, and Rules and Regulations of the Sen Joaquin Lesal Health District.Home ewnw or licen- <br /> sed agents signalvre certifies the following: . <br /> "I certify that In the performance of the work for whish this permit Is Issued, I shell net employ any person in such manner <br /> as to became,subject to wor 's compannialicipjaws of califomia." <br /> Signed_...._...__.__.:---.-.` .... ......... - Owner <br /> By _.......................:_._.__- _........_. ...... <br /> . - _. .._Title....... ✓...!1� +�.�/L..PNn..._. <br /> [if other than owner! ........- -. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY...... -_ ...................._.. DATE._.fCL_'4k-.7L.............. <br /> BUILDING PERMIT ISSUED ._-._------------------ -----------_ ..DATE ........--.............................._. <br /> ADDITIONALCOMMENTS _._.--._-.._....__......._.._........................._._.._.._............................................_.............-................... <br /> _._-......_........:............___........ <br /> ._...- _...._...._._.......__-......._.__--.....-.__._..._...-...__....................... <br /> __... -_ ........... <br /> ...--......._.._............:..._.._.-_ .__.... _....-_..... _ _ .. _ <br /> _. _.............___-___ ... .-.._...._..._.._......__._.__..._..........._..._._......._...._.__...._.... - <br /> Fln.alinspectionby ._.r.... ..........__._. ..........Date._-__P.T_-?�.p__.7 ........... <br /> • SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E.H. 9 1 68 Ray.5M <br />